HomeMy WebLinkAboutX2021-2613 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
I— Comm] F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding F_ Grading
rDrainage j-Elec j`Mech F-PlumCUYdCut s CuvdFill F
Project Address (Not mailing address) f— Flood r Fire r Liq [7 Landslide F_N/A Floor Suite No
Description of Work
Use I— Const Type F_
LOG k wd
1Veo✓
# Stories # Units (if Res)s
Valuation $
New/Add SFs—
Remodel SFF—
Garage/New/Add r—
Material/Labor
OWNER'S NAME
Last
First
Owner's Address
Owner's E-mail Address
City
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City
State �—
Zip �— Telephoner
ARCHITECT/DESIGNER'S NAME
Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_
Zip F— Telephone—
ENGINEER'S NAME
Last
First F Lic. NoF
Engineer's Address
Engineer's E-mail Address
City
State F—
—
Zip I TelephoneF
CONTRACTOR'S NAME/COMPANY j 1 ff' Lic. No. 3d S Class
Contractor's Address
ConhSctor s E-mail
CPtt�L (\CK L
'Address
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Zip Telephone 7,`e-zZ.s�'l�jd,�
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St 1 BACKS HOAR
SETBACKS LEFT
USE ZONE
tit: I bAUKS hHUNI
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. 21 GOZI-Lb1917( 1,0Z1-Lcr-1
PLAN CHECK NO. ZZ?Lt-ZOzt
PLAN CHECK FEES $